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The Shaken Baby Syndrome Myth renamed "Abusive Head Trauma" or "Non-Accidental Injury"
1. SBS
"MYTH" WEBSITE SUMMARY SUBJECT: Dr. John Caffey's SBS Junk Science No
More SHAKEN BABY SYNDROME. Now
it's Shaken impact. ABUSIVE
HEAD TRAUMA: A NEW NAME FOR SHAKEN BABY SYNDROME http://jama.ama-assn.org/content/181/1/17.short (abstract only) JAMA. 1962;181(1):17-24. doi: 10.1001/jama.1962.03050270019004 The Battered-Child Syndrome C. Henry Kempe, M.D.; Denver; Cincinnati; Denver Abstract The battered-child syndrome, a clinical condition in young children who have received serious physical abuse, is a frequent cause of permanent injury or death. The syndrome should be considered in any child exhibiting evidence of fracture of any bone, subdural hematoma, failure to thrive, soft tissue swellings or skin bruising, in any child who dies suddenly, or where the degree and type of injury is at variance with the history given regarding the occurrence of the trauma. Psychiatric factors are probably of prime importance in the pathogenesis of the disorder, but knowledge of these factors is limited. Physicians have a duty and responsibility to the child to require a full evaluation of the problem and to guarantee that no expected repetition of trauma will be permitted to occur.
The Origin of Shaken Baby Syndrome: An Unproven Hypothesis Accepted As Medical Theory Without A Scientific Basis. Caffey's first article was published in 1972. this is the second of his two articles that created the junk science foundation of Shaken Baby Syndrome. John
Caffey, Radiologist: Whiplash-shaken Baby Syndrome 1 Departments of Radiology and Pediatrics, University of Pittsburgh School of Medicine, and the Children's Hospital of Pittsburgh Our evidence, both direct and circumstantial, indicates that manual whiplash shaking of infants is a common primary type of trauma in the so called battered infant syndrome. It appears to be the major cause in these infants who suffer from subdural hematomas and intraocular bleedings. The label "battered infant" is a misnomer in many cases which may interfere with early diagnosis and proper preventive treatment. The essential elements in the infantile whiplash shaking syndrome present an extraordinary diagnostic contradiction. They include intracranial and intraocular hemorrhages, in the absence of signs of external trauma to the head or fractures of the calvaria, and are associated with traction lesions of the periosteums of the long bones in the absence of fractures and traumatic changes in the overlying skin of the extremities. Usually there is no history of trauma of any kind. Habitual, prolonged, casual whiplash shakings may produce an insidious progressive clinical picture, the latent whiplash shaken infant syndrome, which is often in apparent to both parents and physicians. It usually first becomes evident at school age when minor idiopathic cerebral motor defects are first detected along with mild idiopathic mental retardation. Permanent impairments of vision and hearing may also be identified at this time for the first time when the children are 5 to 6 years of age. The actual number of such cases is incalculable from current evidence but it appears to be substantial. This concept of the whiplash shaken infant syndrome warrants careful diagnostic consideration in all infants with unexplained convulsions, hyperirritability, bulging fontanel, paralyses, and forceful vomiting singly or in combination. The routine careful examination of the ocular fundi of all infants should provide a superior screening method for early and massive detection of pathogenic whiplash shakings along with radiographic examination of the long bones for confirmation in appropriate cases. Current evidence, though manifestly incomplete and largely circumstantial, warrants a nationwide educational campaign on the potential pathogenicity of habitual, manual, casual whiplash shaking of infants, and on all other habits, practices and procedures in which the heads of infants are habitually jerked and jolted (whiplashed). The proposed nationwide educational campaign against the shaking, slapping, jerking, and jolting of infants' heads is summarized in the following stanza: Guard well your baby's precious head, Shake, jerk and slap it never, Lest you bruise his brain and twist his mind, Or whiplash him dead, forever. ************************************************* World-renowned
Vitamin C Deficiency Expert Analyzes Dr. Caffey's False Hypothesis C. Alan
B. Clemetson, M.D. Caffey focused on radiologic findings, but while he was aware of the possible diagnosis of scurvy, the radiologic signs of infantile scurvy may not have had sufficient time to develop. Other findings in his cases were compatible with scurvy due to toxic histaminemia, which can cause capillary fragility, retinal petechiae, and subdural hematoma. Although dietary vitamin C deficiency is very rare today in our country, both vitamin C deficiency and toxic histaminemia can accompany systemic infection. Toxic histaminemia may also occur following immunizations. Skeletal Findings in Caffey's Cases The radiologic signs of scurvy, however, are variable.
The most consistent finding used to be elevation and calcification
of the periosteum of the long bones due to subperiosteal hemorrhage,
above and below the fracture sites. In reviewing Caffey’s six
original cases, this finding was present in most of the cases. And,
although osteopenia and contrasting white lines of healing are said
to be characteristic radiological features of classical scurvy, absence
of these findings on radiographs does not rule out a s scorbutic state.The
precise time course of increased susceptibility to fractures
and the development of osteopenia and white lines of healing seen
on radiographs is not known. Bones may be vulnerable to fracture because
of proline and lysine hydroxylase deficiencies affecting chondroblasts
and osteoblasts before these classic radiological signs appear, especially
if scurvy develops rapidly at an early age. Additional Findings in Caffey’s Case Studies A Multifactorial Cause? Conclusions The so-called “classic” findings of subdural
hematoma and retinal hemorrhages in infants, without any evidence
of major trauma, do not always automatically equate to a diagnosis
of
********************************************************************************************** Spontaneous Or Accidental Causes of
Subdural Hematomas American Journal
of Neuroradiology 27:1725-1728, September 2006 BACKGROUND AND PURPOSE: Patients who have benign enlargement of the subarachnoid spaces (BESS) have long been suspected of having an increased propensity for subdural hematomas either spontaneously or as a result of accidental injury. Subdural hematomas in infants are often equated with nonaccidental trauma (NAT). A better understanding of the clinical and imaging characteristics of subdural hematomas that occur either spontaneously or as a result of accidental trauma may help distinguish this group of patients from those who suffer subdural hematomas as a result of NAT. The purpose of this study is to describe the clinical and imaging characteristics of subdural hematomas that occur either spontaneously or as a result of accidental injury in infants with BESS. RESULTS: During the study period, 7 patients with BESS complicated by subdural hematoma were identified. Their mean age at identification of the subdural hematoma was 7.4 months of age. In 5 cases, there was no recognized trauma before identification of the subdural hematoma. In 3 cases, baseline CT or MR imaging was available, showing prominent subarachnoid spaces without any evidence of subdural hemorrhage. CONCLUSION: Although suspicious for NAT, subdural hematomas can occur in children either spontaneously or as a result of accidental trauma. Caution must be exercised when investigating for NAT based on the sole presence of subdural hematomas, especially in children who are otherwise well and who have BESS. **************************************************************************************** Older Children With The Same Symptoms As Infants Assumed To Have Been Shaken: Discrediting Theories About "Shaken" Brain Injury In Infants Due To Weak Necks and Soft Brains (no neck injury means no shaking occurred) http://pediatrics.aappublications.org/cgi/content/abstract/117/5/e1039 Published
online May 1, 2006 a
Department of Ophthalmology, University of California Davis Medical
Center, Sacramento, California ABSTRACT Shaken-baby syndrome (SBS) has been hypothesized to occur after shaking by an adult during the first 2 years of life. We wondered whether it is possible to achieve rotational forces sufficient to cause SBS-like injuries in children >2 years of age. The present study describes cases of child abuse in older children who presented with the classic ophthalmologic and intracranial findings of SBS. In this case series, 4 cases of older children (2.5–7 years old; 11.8–22 kg) who died from abusive head injuries and who had diffuse retinal hemorrhages identified antemortem were selected for review. The cases were abstracted from hospital charts, records from autopsies, coroners' and district attorneys' offices, and court transcripts. In all 4 cases the history provided by the primary caregiver did not match the severity of the injuries. Three case subjects presented with patterned bruises. Multilayered retinal hemorrhages and acute subdural hematoma were observed in all 4 cases. At autopsy, diffuse axonal injury was evident in 3 of the 4 cases; all 4 cases had optic nerve sheath hemorrhages. None of the victims had skeletal fractures on radiologic examination or at autopsy. This case series demonstrates that it is possible to observe SBS-like retinal and central nervous system findings in the older and heavier child. Our findings underscore the need for providers to consider intentional shaking as a mechanism of injury in the evaluation of abusive head injury in older children. Accepted
Nov 7, 2005. *********************************************************************************** Wrongful Diagnosis http://jrsm.rsmjournals.com/cgi/content/full/98/6/249 Wrongful
diagnosis of child abuse—a master theory *********************************************************************** How ASSUMPTIONS Are Accepted As Facts: http://radiographics.rsnajnls.org/cgi/content/abstract/23/4/811 DOI:
10.1148/rg.234035030 AFIP ARCHIVES 1 From the Department of Radiologic Pathology, Armed Forces Institute of Pathology, 14th and Alaska Sts NW, Bldg 54, Rm M-121, Washington, DC 20306-6000 (G.J.L.); Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (G.J.L.); Hennepin County Medical Examiner’s Office, Minneapolis, Minn (A.M.B., M.K.M.); and Armed Forces Center for Child Protection, National Naval Medical Center, Bethesda, Md (S.C.B.). Received February 10, 2003; revision requested March 24 and received March 31; accepted April 4. Address correspondence to G.J.L. (e-mail: glonergan@mac.com). In the United States, roughly one of every 100 children is subjected to some form of neglect or abuse; inflicted injury is responsible for approximately 1,200 deaths per year. Child physical abuse may manifest as virtually any injury pattern known to medicine.* Some of the injuries observed in battered children are relatively unique to this population (especially when observed in infants) and therefore are highly suggestive of nonaccidental, or inflicted, injury. Worrisome injuries include rib fracture, metaphyseal fracture, interhemispheric extraaxial hemorrhage, shear-type brain injury, vertebral compression fracture, and small bowel hematoma and laceration. As noted, however, virtually any injury may be inflicted; therefore, careful consideration of the nature of the injury, the developmental capabilities of the child, and the given history are crucial to determine the likelihood that an injury was inflicted. The majority of these injuries are readily detectable at imaging, and radiologic examination forms the mainstay of evaluation of child physical abuse. Detection of metaphyseal fracture (regarded as the most specific radiographically detectable injury in abuse) depends on high-quality, small field-of-view radiographs. The injury manifests radiographically as a lucent area within the subphyseal metaphysis, extending completely or partially across the metaphysis, roughly perpendicular to the long axis of the bone. Acute rib fractures (which in infants are strongly correlated with abuse) appear as linear lucent areas. They may be difficult to discern when acute; thus, follow-up radiography increases detection of these fractures. For skull injuries, radiography is best for detecting fractures, but computed tomography and magnetic resonance imaging best depict intracranial injury. ************************************************************************************ Intracranial Hemorrhage Unrelated to Child Abuse http://aapgrandrounds.aappublications.org/cgi/content/full/17/5/54 Neonatal
Intracranial Hemorrhage May Be More Frequent than Previously Suspected ********************************************************************************** British Medical Journal Responses: SBS http://www.bmj.com/cgi/eletters/328/7442/719 (response page) Retinal haemorrhages and SBS. Fact or Fantasy? Editor, The Shaken Baby Syndrome (SBS) is receiving renewed attention by the Ophthalmology Child Abuse Working Party (OCAWP) deciding to develop new “guidelines” for the diagnosis of retinal haemorrhages associated with intracerebral haemorrhages. The first essential of their endeavour should be to establish the validity of the diagnosis of SBS. Does such a condition exist or is it the diagnosis of those who “think dirty” when unable to explain a particular group of signs and symptoms in a child? Of 21 cases of alleged child abuse sent to me for my opinion from four countries including the UK, USA and Australia, 16 had retinal, intracerebral and other haemorrhages with or without fractures. All 16 were either vaccinated within 21 days of the onset of their symptoms or had documented evidence of a haemostatic, liver or nutritional disorder. All had a history of Apnoea at the onset of their symptoms. If the OCAWP seek to guide the profession on the distinction between accidental and non-accidental retinal haemorrhages they must first document a SINGLE case of retinal haemorrhages associated with intracerebral haemorrhages that did not occur within 21 days of being vaccinated and had no evidence of a haematological, liver or nutritional disorder, Since the authors declare they have served as expert witnesses in suspected non-accidental injury they will obviously have a number of cases upon which they can draw to produce just ONE ADEQUATELY INVESTIGATED CASE of SBS with none of the features mentioned above. If between them they cannot produce a single case they should admit that the concept of Shaken Baby Syndrome is an aberration unworthy of inclusion in the Medical lexicon. Michael D Innis MBBS; DTM&H; FRCPA; FRCPath. Shaken
baby syndrome or another diagnosis? 7 April 2004 Send response
to journal:
We read the recent papers and editorials on the shaken baby syndrome with great interest (1,2,3). These discuss the possible aetiology of this disorder, but fail to address the differential diagnoses which need to be taken into account when confronted with a baby with the findings of acute encephalopathy accompanied by subdural and retinal haemorrhages. In view of not only the medico-legal, but also the diagnostic and possible therapeutic aspects, we wish to draw attention to other disorders which may mimic the shaken baby syndrome. In the first place coagulation disorders may have a similar presentation (4). They need to be investigated and, if present, treated urgently. A second disorder which may present in an identical manner to the shaken baby syndrome is hemophagocytic lymphohistiocytosis (HLH) (5,6). In a recent article Rooms et al. (5) report 3 cases showing that presentation of this disorder may be indistinguishable from the shaken baby syndrome. This rare disorder is caused by an abnormal proliferation of histiocytes in tissues and organs. It usually presents with fever, hepatosplenomegaly, pancytopenia, hypertriglyceridemia and coagulation disorders. However, it may also present with central nervous system manifestations ranging from irritability to encephalopathy and coma. Clinical findings include retinal and intracranial haemorrhages. When untreated this disorder is fatal. Optimal treatment consists of allogeneic bone marrow transplantation and cytotoxic and immunosuppressive therapy. The presence of anaemia, thrombocytopenia, abnormal liver enzymes and hepatosplenomegaly as well as coagulation disorders should raise suspicions of HLH. More extensive investigations including bone marrow aspiration, T2 weighted MRI scan of the brain, triglyceride and serum ferritine levels will be necessary to confirm the diagnosis. As shown in the papers and ensuing correspondence in your journal, the impact for all concerned, of the diagnosis of shaken baby syndrome is enormous (7,8). Therefore it is essential that other possible causes are eliminated before this diagnosis is pronounced. 1. Geddes JF, Plunkett J. The evidence base for shaken baby syndrome. BMJ 2004;328:719-720 2. Harding B, Risdon RA, Krous HF. Shaken baby syndrome. BMJ 2004;328:720- 721 3. Lantz PE, Sinal SH, Stanton CA, Weaver Jr RG. Perimacular retinal folds from childhood head trauma. BMJ 2004;328:754-756 4. Vorstman EB, Anslow P, Keeling DM, Haythornwaite G, Bilolikar H, McShane MT. Brain haemorrhage in five infants with coagulopathy. Arch Dis Child 2003; 88: 1119-21 5. Rooms L, Fitzgerald N, McClain KL. Hemophagocytic lymphohistiocytosis masquerading as child abuse: presentation of three cases and review of central nervous system findings in hemophagocytic lymphohistiocytosis. Pediatrics 2003;111:e636-40 6. Hallahan AR, Carpenter Pa, O’Gorman–Hughes DW, Vowels MR, Marshall GM. Haemophagocytic lymphohistiocytosis in children J. Paediatr Child Health 1999; 35: 55-9 7. Minns RA, Busuttil A. Four types of inflicted brain injury predominate. BMJ 2004;328:766 8. LeFanu J, Edwards-Brown R. Subdural and retinal haemorrhages are not necessarily signs of abuse. BMJ 2004;328:767 ********************************************** In The 1930's Scurvy Was
Considered As The Cause Of Subdural Hematomas By Stephen Lazoritz, Vincent J. Palusci
Dianne Jacobs Thompson Est. 2007 Also http://truthquest2.com (alternative medicine featuring drugless cancer treatments) Author publication: NEXUS MAGAZINE "Seawater--A Safe Blood Plasma Substitute?"
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